The National Health Accounts Process in Mali HEALTH DIVISION DOCUMENT HEALTH DIVISION DOCUMENT HEALTHDIVISION DOCUMENT HEALTH DIVISION

MARCH 2006 • HEALTH DIVISION

Health Division Document 2006:2 Issue Paper on NHA

The National Health Accounts process in Mali HEALTH DIVISION DOCUMENT HEALTH DIVISION DOCUMENT HEALTHDIVISION DOCUMENT HEALTH DIVISION

HEALTH DIVISION DOCUMENT HEALTH DIVISION DOCUMENT HEALTH DIVISION DOCUMENT HEALTH DIVISION DOCUMENT DIVISION HEALTH DOCUMENT DIVISION HEALTH HEALTH DIVISION HEALTH DOCUMENT DIVISION HEALTH DOCUMENT

Content

Executive Summary ...... 3

Abbreviations ...... 4

1. Background ...... 5 1.1. Objectives and Method ...... 5 2. Overview of the Malian Health Sector ...... 7

3. Overview of the NHA Process in Mali ...... 9

4. The Current NHA Study, 1999–2004 ...... 11 4.1. Objectives ...... 11 4.2. Steering committee and the NHA technical team ...... 12 4.3. Data ...... 12 4.4. Expected results ...... 13 4.5. Sub-analysis ...... 13 5. Discussion and Concluding Remarks ...... 14

References ...... 16

List of Health Division Documents ...... 18

1 The views and interpretations expressed in this document are the author’s, and do not necessarily reﬂ ect those of the Swedish International Development Cooperation Agency, Sida.

Published by Sida 2006

Department for Democracy and Social Development

Author: Frida Hjalte, IHE, The Swedish Institute for Health Economics

Printed by Edita Communication AB, 2006

Art. no.: SIDA26893en

ISBN 91-586-8262-7

ISSN 1403-5545

This publication can be downloaded/ordered from www.sida.se/publications 2 Executive Summary

National Health Accounts (NHA) is recognised as a valuable tool in policymaking and decision-making within the health sector. The method helps identifying the sources of funds, how the funds are channelled to providers, and for what functions the funds are used. NHA is of specif c interest for developing countries since these countries often face a considerable burden of disease and shortage of resources. This paper gives a presentation of the process of the Mali NHA. Over the years there have been a few attempts to provide a comprehensive picture of the f ow of funds within the Malian health sector. The f rst tentative NHA was developed in the 1980s and the second attempt, covering the years 1988-1991, was published in 1993. In 2002, a NHA feasibility study was conducted in Mali but no accounts were elaborated at that time. The structure of the health system in Mali has changed considerably since then. A private sector has emerged and an increased number of providers are now providing health care services. In 2005, the f rst NHA study conducted according to international comparable methodology was initiated in Mali. A national research institute for public health is technically responsible for the current study. The data collection will be f nalised before the end of year 2005 and a dissemination of results is scheduled for the f rst half of year 2006. There are some challenges ahead for the NHA process in Mali. The f rst challenge is for the stakeholders in the health sector to interpret and actually use the results of the f rst round. The second challenge, connected to the f rst one, is the important issue of institutionalising the NHA process. In order to facilitate the institutionalisation process, Mali is in need of support. For example, to be able to attend training workshops and participate in network activities f nancial support is needed. It is a strength for the institutionalisation process that Mali has former experiences and possesses local expertise in the production of NHA. The fact that the next demographic and health survey (DHS) in Mali will include a household health expenditure component will certainly have a positive effect in facilitating future NHA studies and the institutionalisation process. Further, the steering committee of the current study plays, and will play, a key role in assuring the institutionalisation in Mali. It will thus be of great interest to follow the development of the Malian health sector and see how the results from the NHA will be received by the steering committee and how the results will actually inf uence the policy making within the country.

3 Abbreviations

AIDS Acquired Immunodef ciency Syndrome CNS Comptes Nationaux de la Santé National Health Accounts (NHA) CPS Cellule de la Planif cation et de Statistique Planning and statistical unit CSC Centre de Santé de Cercle CSCOM Centre de Santé Communautaire EDSM Enquête Demographique et de Santé au Mali Demographic and Health Survey (DHS) EU European Union FA Francophone Africa FCFA Franc Communauté Financière Africaine HIV Human Immunodef ciency Virus IHE The Swedish Institute for Health Economics INRSP Institut National de Recherche en Santé Publique MoH Ministry of Health NGO Nongovernmental Organisation NHA National Health Accounts PDDSS Plan Décennal de Développement Sanitaire et Social PHRplus Partners for Health Reformplus PRODESS Programme de Développement Sanitaire et Social Sida Swedish International Development Cooperation Agency SWAp Sector Wide Approach UNICEF United Nations Children Fund USAID United States Agency for International Development WB World Bank WHO World Health Organization

4 1. Background

Many developing countries face a considerable burden of disease togeth- er with a shortage of resources. These countries need to improve their health systems and the use of resources to better meet the necessities of the population. Improving health systems and making appropriate allocation decisions require reliable and current data on f nancing as well as complementary non-f nancial information. One internationally recognised tool intended to give a full picture of the expenditures on health is National Health Accounts (NHA). NHA provides information of the f ow of funds within the health sector. It identif es the sources of funds, how the funds are channelled to the providers, and for what functions the funds are used. Currently, about 80 countries around the world have produced NHA at least once and approximately 60 of them are low- and middle-income countries. In January 2003, the concept of NHA was formally launched in Central and West Africa at a meeting in Dakar, Senegal. At that meeting, the Francophone West and Central African Regional NHA Network (FA) was established in order to facilitate the exchange of information and experiences between the countries. The FA network includes around 25 countries.1 In October 2003, a f rst regional NHA technical training workshop was held in Dakar where 12 countries, including Mali, were represented.2 In Mali, there was an early interest in exploring the f nancing of the health sector, i.e. in the late 1980’s the f rst tentative NHA was elaborated. After a second attempt in the beginning of 1990’s the f rst NHA produced according to international comparable methodology was commenced in 2005. In January-February 2004 the Swedish Institute for Health Economics (IHE) conducted a study on the status of NHA and the use of health expenditure data in Mali (Glenngård and Hjalte, 2004). The current report is a follow-up of the study from 2004.

1.1. Objectives and Method This paper mainly focuses on the ongoing NHA process in Mali. The objective of the paper is to present the procedure, the objectives and the expectations with NHA in Mali. First, a presentation of the current

1 The FA countries include Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Congo, Madagascar, Mali, Niger, Rwanda, Senegal, Togo, Algeria, Burundi, Central African Republic, Comoros, Côte d’Ivoire, Equatorial Guinea, Gabon, Guinea, Guinea Bissau, Mauritania, São Tomé and Principe and Seychelles. 2 The other participating countries were Benin, Burkina Faso, Cameroon, Cape Verde, Chad, Congo, Madagascar, Niger, Rwanda, Senegal and Togo. 5 situation of the Malian health sector is given. Secondly, a brief overview of the NHA process in the country is presented. This is followed by a description of the characteristics of the current NHA round, the objectives and the expectations. The paper is ended by a discussion and some concluding remarks. The study is based on interviews conducted with different stakeholders in the Malian health sector. The interviews were semi structured and took place in Bamako in November 2005. Respondents were selected based on the identif cation of respondents for the study in 2004 and according to their current managing position in the health sector and/or their involvement in the Malian NHA process. The respondents included representatives from the Ministry of Health (MoH), national research institute in public health, WHO, Sida, USAID, and Netherlands.

6 2. Overview of the Malian Health Sector

Mali is situated in West Africa and the country is composed of 8 regions plus the district of Bamako, the capital city. Mali is one of the world’s poorest; rated 174 of 177 according to the UNDP Human Development Index, 2004. The development indicators are very poor; in 2003, life expectancy at birth was 40.6 years, infant mortality was 122 per 1,000 live births and fertility rate was 6.4 children per wom- an (World Development Indicators 2004). Malaria and other preven- tive diseases are the main causes of illness and death in Mali. A large part of the diseases origins from poor environmental conditions with lack of clean water and appropriate waste disposals. Respiratory infections, diarrhoea, malaria and malnutrition are the most important health problems among children. Mali’s HIV/AIDS prevalence is low, i.e. 1.7 percent, in relation to the rest of Sub-Saharan Africa (Demographic and Health Survey-2001). As in many countries in the region, corruption continues to be an extensive problem in the Mal- ian public administration.3 The f rst health sector reform in Mali (Politique Sectorielle de Santé et de Population) started in 1990. Since then, Mali has focused on primary health care and local participation according to the Bamako Initiative.4 The goal has been to achieve f nancial participation by the citizens and to provide a minimum package of health care for the whole population. In 1997 the Ministry of Health (MoH) developed a health and social plan for 10 years, PDDSS (Plan Décennal de Développe- ment Socio Sanitaire), which covers the years 1998-2007.5 The implementation of this ten-year national strategy for development of the health and social sectors is, however, delayed. The f rst f ve-year implementation plan covered the years 1998-2002 (extended to 2004), i.e. the PRODESS I (Programme de Développement Sanitaire et Social). The second f ve-year plan of the PDDSS is described in the PRODESS II and covers the years 2005–2009 (PRODESS II, 2004). In 2004, the

3 According to the latest report by Transparency International (2005) Mali received a Corruption Perceptions Index (CPI) score of 2.9 (on a scale where 10=highly clean and 0=highly corrupt). 4 The Bamako Initiative was a new health strategy based on community participation, adopted by African Ministries of Health in 1987. A central component within the initiative was to make essential drugs available to the main part of the population. 5 The objectives with the plan are to decrease the prevalence and mortality of the main diseases, increase both the fi nancial and geographical availability of health care services, fi ght the social exclusion of the health care services, increase the social mobilisation for health, develop alternative forms of health care fi nancing, and develop the skills of the health care staff 7 Minister of Health in Mali changed, which was viewed as an important step for improvement of the management of the health sector (Sida, 2005). Bilateral donors and multilateral organisations are important f nancing sources in the Malian health sector. Large multilateral organisations giving support are the World Bank (WB), the World Health Organiza- tion (WHO), the European Union (EU) and the United Nations Chil- dren Fund (UNICEF). Large bilateral donors are: the USA, the Nether- lands, France and Canada. Most of these cooperating partners are giving support under the sector-wide approach (SWAp). Further, there are several Nongovernmental organisations (NGOs) working in the Malian health sector. Since 1992 there is an umbrella organisation for national NGOs, with some international partners as well, called Groupe Pivot de Santé et Population (GPSP). This organisation is working with competence building for its members and strengthening the cooperation between the NGOs and the MoH. Besides these sources of funds the households account for a signif cant part of the health care expenditures in the country. Health care is mainly publicly provided in Mali. After the independ- ence in 1960 private health care was not allowed. Private providers were allowed again in 1985 but their extension is still rather restricted and they are mostly found in the urban areas of the capital. Even though it is diff cult to obtain any written documentation on the use of traditional medicine, this form of health care is extensively used in Mali. The wide variety of health care providers in Mali includes the following; public and para-statal health centres, private health centres, health centres belonging to enterprises or the military army, mutual and insurance companies, public and private health care schools, pharmacies, traditional therapists and NGOs. At the lowest level of care in the public Malian health care system there are 674 community health centres (CSCOMs). These clinics provide a minimum package of health care. The district level includes 55 district health care centres (CSCs). The district health centres are prima- rily f nanced by public means and donors, supplemented by user fees. The hospital level is composed of 7 regional hospitals and 4 national hospitals. The MoH has a policy making and coordinating role in the system. Three Demographic and Health Surveys (DHS) have been undertaken in Mali, the DHS-1987, DHS-1995/96 and the DHS-2001. They have been conducted by the Planning and Statistics Unit, CPS (Cellule de Planif cation et de Staistique), the National Directorate of Statistics and Computer Science, DNSI (Direction Nationale de la Statestique et de lÍnformatique), with technical assistance from an Opinion Research Corporation company (ORC Macro). The data collection for the next DHS will start in the beginning of 2006. Compared to the previous DHS that did not include a component with household expenditures on health this next survey will include such a component.

8 3. Overview of the NHA Process in Mali

In Mali, NHA was on the agenda quite early compared to other countries in Sub-Saharan Africa. There have been two major efforts in exploring the f nancing of the Malian health sector. Both these attempts to create NHA in Mali have been undertaken by researchers at a national research institute for public health, i.e. the INRSP (Institut National de Recherche en Santé Publique). The f rst study, covering the years 1983 to 1987 was demanded by the WHO and f nanced by USAID (Ministère de la Santé Publique et des Affaires Sociales et al., 1989). The second study covered health expenditure data from the years 1988 to 1991 and was f nancially supported by UNICEF (Coulibaly and Keita, 1993). The latter study, published in 1993, encountered a major problem in the data collection concerning household expenditures on health. In addition, the available information and documents at the MoH were rather limited. The bookkeeping and the f nancial management carried out by the MoH and the collection of health information was inappropri- ate and irregular, often including overestimated f gures. All health care facilities were to be surveyed but because of the unstable political situation in the northern parts of the country it was not possible to cover all regions. The team attempted to collect all available data for the period 1988 to 1991 concerning the expenditures of recurrent activities and investments, the revenues, and the frequency of different services. How- ever, some information was incomplete, some documents had disap- peared, and some of the respondents were unwillingly to provide the requested information. Further, reluctance to provide information appeared to be a common problem within the private sector probably because of a suspicion of tax augmentations. When considering the private sector and its reporting and information systems, it was denoted as “total anarchy” (Coulibaly and Keita, 1993, p. 65). Total funds received from the government were known but the facilities were often unable to provide detailed information on their expenditures, why the team estimated expenditures for the periods where no actual data was available. A major f nding of the Mali 1988-91 NHA was the actual structure of the f nancing sources for health care in Mali. Prior to the study, this information was relatively unknown. The households accounted for a substantial part of the health expenditures, i.e. 75 percent, whereas the government accounted for 20 percent and the international sources including NGOs, bilateral donor organisations and international organi-

9 sations accounted for 5 percent. Since the main part of the Malian population lived below the poverty line the fact that the households accounted for such a signif cant part was a remarkable and striking result. Further, the NHA report from 1993 concluded that, by that time, and with the poor quality of health expenditure data and information on health activities, no routine production of NHA would be possible in Mali. A main recommendation was therefore that the health care facilities f rst should establish health information systems and start using them. Then all information would be compiled and available at the central level and NHA could be developed at a reasonable cost. According to the interviews the results from these two f rst studies of the expenditures on health in Mali have been widely used by the MoH in their organisation of funds for the health sector. In the beginning of year 2000 the Malian MoH, with a highly con- cerned health minister, expressed a renewed interest in conducting NHA in Mali. In addition, cooperating partners demanded data in accordance with international formats and standards. Hence, a NHA feasibility study was carried out for investigating the health care f nancing in Mali (Keoula, 2002) and development of NHA was included in the operational program (activités opérationnelles) within the PRODESS for the years 2000 and 2001. The feasibility study aimed at clarifying potential problems with a NHA study and was f nanced by a research institute, l´Institut de Recherche pour le Développement (IRD)6. In 2002 when the report was f nalised and was to be presented to the MoH the government changed and the involved staff at the MoH was replaced. This resulted in that no NHA was initiated in Mali. After the NHA launching meeting in Dakar in January 2003, a budget for developing NHA was again incorporated in the operational plan for 2003. In October the same year representatives from Mali attended the f rst technical training workshop of the West and Central African Regional NHA network, which was held in Dakar.

6 The IRD is a French public science and technology research institute under the joint authority of the French ministries in charge of research and overseas development. The research is focused on Mediterranean and tropical regions and has the objective of contributing to the sustainable development of these countries. 10 4. The Current NHA Study, 1999–2004

At present, a NHA study is under way in Mali, covering the years 1999 to 2004. The protocol for the study was f nalised in March 2005 (Diakité et al., 2005). The timeframe for the study is ten months, from the launching of the study to the dissemination of the results. A draft report was supposed to be ready by the end of the year 2005 but it has been delayed. According to respondents, however, the results will probably be disseminated during the f rst half of 2006. The study is supported by the MoH, WB, WHO, EU, France, Netherlands, Canada and USAID. The budget for the Mali NHA is FCFA 76,995,000 7, not including the sub-analysis. The def nition of health care activities used is in accordance with the def nition in the OECD System of Health Accounts (SHA). The production of NHA tables will be undertaken according to the standard set of tables described in the NHA Producers Guide (WHO, 2003), i.e. Financ- ing Sources (FS) X Financing Agents (HF), Financing Agents (HF) X Providers, Financing Agents (HF) X Functions (HC), Providers (HP) X Functions (HC). Two supplementary tables will be added for Mali. One is Financing Agents according to level in the health system and the other is Financing Agents according to poverty zone since the level of poverty differs across the country. 8 There have been no NHA training workshops or meeting within the FA network since the ones held in Dakar, Senegal 2003. However, in December 2005 the Centre Africain d´Etudes Supérieures en Gestion (CESAG) organised a NHA training seminar in Dakar, Senegal. Unfortunately, no representatives from Mali participated due to lack of funding.

4.1. Objectives According to the NHA protocol the specif c objectives with the current NHA in Mali are as follows: – To identify the different f nancing sources and their respective contri- bution in the health sector

7 1000 FCFA= 1.55 EUR, November 2005 8 The country is divided into three zones of poverty; Zone 1: Very poor - includes 66 percent of the population in Mali and covers the regions of Mopti, Koulikoro, Ségou and Sikasso. Zone 2: Average poor- covers 21 percent of the population and the regions of Kayes, Tombouctou, Gao and Kidal. Zone 3: Less poor- is composed of the district of Bamako with 13 percent of the population (PRODESS II, 2004). 11 – To describe the evolution of health expenditures over time and understand its f uctuations – To measure the government health expenditure per capita – To institutionalise the production of NHA in Mali.

4.2. Steering committee and the NHA technical team The NHA process in Mali is lead by a steering committee (comité de pilotage), composed of representatives from the different departments of the MoH, the cooperating partners (WHO, EU, WB, France, the Neth- erlands, USAID) and the INRSP. The cooperating partners included in the steering committee provide funding for the study. Further, a technical team, composed of researchers at the national research institute (i.e. INRSP), is responsible for conducting the accounts. Two external con- sultants are supporting the technical team and will regularly come to Mali in order to support and critically assess their work. The steering committee has a validating role in the elaboration and is commissioned to give feedback and resolve problems encountered by the technical team. It is worth noting that the steering committee plays a key role in assuring the institutionalisation of the production of NHA given that it is composed of policymakers in the health sector.

4.3. Data The data collection for the current NHA includes both primary and secondary data collection. The collection of primary data regarding allocation and utilisation of funds is conducted through distribution of questionnaires. Six different questionnaires have been constructed, i.e. questionnaires for Financing sources, Financing Agents, Providers, Non- governmental organisations, Central Services and Insurance companies. The collection of secondary data consists of reviewing documents and existing, recently collected data. This will form the base for the estima- tion of the household expenditures. Institutional data is collected for the years 1999 to 2004 while the household data only will be estimated for 2004. In the two earlier studies, performed in the late 1980´s and beginning of the 1990´s, the sample fully covered the central and district levels in all regions in the country but the northern ones due to safety reasons. Since the beginning of the 1990´s, the health system in Mali has, however, changed considerably and a private sector has emerged. The number of providers that is now providing health care services has signif cantly increased. Today, there are approximately 700 CSCOMs while in 1990 there was only one. Further, in 1990 there was only one mutuelle (mutual insurance company) and now there are at least 40. The number of pharmacies have also increased from only a few concentrated to Bamako in the beginning of the 1990´s to a current number of around 300 being spread all over the country. At the central level the current NHA will investigate all the central structures, i.e. the public, para-statal and all the multilateral and bilateral donor organisations. At regional level all regional off ces will be investigated as well as the regional hospitals. The functioning at the district level can differ between the districts. In order to capture these differences three district health care centres (CSC) in the district of Bamako and three in each region will be investigated, i.e. 27 out of 55 (50 percent). Further, three community health care centres (CSCOM) in each district, i.e. in total 90 out of 674 (14 percent) will be investigated. Note that for accessibility and security reasons some of the CSCOM in

12 the rural parts of the northern regions will not be investigated. When it comes to private pharmacies 28 percent will be investigated. Around 50 percent of the cabinet privées will be investigated and 50 percent of the private clinics. In total, 24 persons have been selected, all with a university diploma, to work with the collection of data. These persons received training in NHA and are divided into teams, each with one supervisor responsible for the work. One team will cover two regions on average. The collected data will be registered by two teams simultaneously and then compared as to identify and minimise errors.

4.4. Expected results The expected results of the current NHA, as described in the protocol, are presented below. – Activity indicators (e.g. the number of consultancies and hospitalisa- tion per person and year) – The distribution of health expenditures between the different f nancing sources – A partition of the health expenditures between recurrent costs and investments – The distribution of health expenditures between regions and between the different levels in the health system – The public, private and external parts of the total health expenditures and their development over time – The share of the general state budget that goes to health care and its development over time

The NHA database will be published at the MoH website. Further, the results and the reports produced will be used in the work of the technical follow-up committee of the PRODESS. Decisions on resource allocation will be made based on the results from the NHA.

4.5. Sub-analysis Three possible sub-analysis for Mali were identif ed by the INRSP, i.e. Malaria, HIV/AIDS and Reproductive Health. Only one sub-analysis is feasible to do at a time and thus the steering committee had to choose one of them. When deciding on which sub-analysis to choose one important difference between the three was identif ed, i.e. data collection from households. Both for the malaria and HIV/AIDS there are already studies on household expenditures, but there is nothing on reproductive health. Thus, a sub-analysis for the latter would require an additional study while for the other two the work with data collection would be less comprehensive. The following budgets for the general NHA plus sub- analysis have been estimated: HIV/AIDS: CFA 100,295,000 Malaria: CFA 100,295,000 Reproductive Health: CFA 119,795,000

Due to the already existing data on malaria in Mali the sub-analysis for malaria was selected. The collection of data for the sub-analysis will be based on the study on the costs of malaria produced by the INRSP in 2004 (Keita et al., 2004).

13 5. Discussion and Concluding Remarks

Over the years there have been several attempts to capture the scope and characteristics of the health expenditures in Mali. The f rst attempt in the late 1980s indicated an early interest and understanding of the importance of a tool like NHA. There is at present an ongoing NHA study in Mali. The accounts are conducted according to international recognised methodology, which will make the results from the study comparable with results from other countries. The study is supposed to be f nalised and disseminated during the f rst half of 2006. It is more than ten years since the last study on health expenditures was conducted in Mali. The future regularity of producing NHA has not been specif ed either in the protocol or by the respondents in this study. Elaborating NHA requires substantial human resources and the fact that Mali is a vast country makes the data collection even more complex. According to some of the interviews future NHA studies would probably be as resource demanding as the current one. The fact that the next DHS will include a household health expenditure component will, however, certainly facilitate future NHA studies in Mali. This means that no separate data collection for the households’ expenditures will be needed. As a result the institutionalisation process of NHA in Mali could be easier. It remains to be seen what results will come out from the current study and especially how these results will be used for policy purposes in Mali. The next challenge for the stakeholders in the health sector will be to interpret and actually use the results. When stakeholders are appreci- ating the benef ts of using the accounts they will demand regularly updated information. This is highly related to the second challenge, i.e. the issue of institutionalisation. Evidence from other studies show that institutionalisation of NHA requires a committed government that uses the results of the accounts (Hjortsberg, 2001; De et al, 2003). It is a strength for the institutionalisation process that Mali possesses local expertise in the production of NHA. The same staff and local research institute that were responsible for the former studies undertake the current one. Mali is in need of at least f nancial support in order to be able to institutionalise NHA. As an example, no one from the country could attend the regional training workshop in Senegal in 2005 due to lack of funding. Nevertheless, it would have been essential for Mali to send representatives to the training workshop since a round of NHA is cur-

14 rently underway. Being a member of the Francophone Africa NHA network it is important to meet with other members in the network in order to share experiences and problems of the NHA implementation and to create contacts for future collaboration. When it comes to the important issue of ownership of the NHA, the steering committee plays and will play a key role in assuring the institutionalisation of the production of NHA in Mali. The steering committee is composed of policymakers and cooperating partners in the health sector and is lead by the MoH. The committee makes all decisions and validations within the NHA process. It will thus be of great interest to follow the development in the Malian health sector and f nd out how the results from the accounts will be received by the steering committee and if and how the results will actually inf uence the policy making within the country in the future.

15 References

Cellule de Planiﬁ cation et de Statistique, Ministère de la Santé, Direction Nationale de la Statistique et de l´Informatique, ORC Macro. (2002). Demographic and Health Survey. Enquête Démographique et de Santé Mali, 2001 (EDSM-III). CPS/MS, DNSI, ORC Macro, Calverton

Coulibaly, S.O., Keita, M. (1993). Les Comptes Nationaux de la Santé au Mali: 1988-1991. Ministère de la Santé, de la Solidarité, et des Personnes Agées, République du Mali, L´Initiative de Bamako Rapport Technique Numéro 18. Juillet.

De, S., Dmytraczenko, T. et al. (2003). Has Improved Availability of Health Expenditure Data Contributed to Evidence-Based Policy-Making? Country Experi- ences with National Health Accounts. PHRplus, Bethseda, Maryland

Diakité, B.D., Diarra, K. and Keita, M. (Mars 2005). Protocole de l´Elaboration des Comptes Nationaux de la Santé au Mali: 1999-2003. Institut National de Recherche en Santé Publique/Département Santé Communautaire, Bamako

Glenngård, A.H. and Hjalte, F. (2004). Issue Paper on NHA – The case of Kenya, Zambia and Mali. Health Division Document 2004:3, Swedish Interna- tional Development Cooperation Agency, Stockholm

Hjortsberg, C. (2001). National Health Accounts – Where are we today? Health division document 2001:6, Swedish international development cooperation agency, Department for Democracy and Social Development Health Division, Stockholm

Keita, M., Diakité, B.D. and Diarra, K. (Septembre 2004). Le Fardeau Economique du Paludisme au Mali. Ministère de la Santé/Institut National de Recher- che en Santé Publique/Département Santé Communautaire, Bamako

Keoula, Y. (2002). Etude de Faisabilité pour la Construction des Comptes Nationaux de la Santé au Mali. Institut de recherche pour le développement (IRD), Juillet, Bamako

Ministère de la Santé / Secretariat General. (2003). Cadre de Dépenses à Moyen Terme 2003-2007. Version 4. MS / SG, Mai, Bamako

16 Ministère de la Santé / Secretariat General/Cellule de Planiﬁ cation et de Statisti- que. (2004). Programme de Développment Socio-Sanitaire, 2005-2009, (PRO- DESS II), Composante Santé, Bamako

Ministère de la Santé Publique et des Affaires Sociales, Institut National de Recher- che en Santé Publique, Division Santé Communautaire. (1989). Le Financement des Couts Recurrents de la Santé au Mali, Bamako

Swedish International Development Cooperation Agency. (2005). Sida Semi-annual Country Report for Mali, January to Mid-November 2005, draft version 16 November 2005

Transparency International. (2005). Global Corruption Report 2005, edited in Berlin by Diana Rodriguez and Gerard Waite and Toby Wolfe, Pluto Press, London

World Bank. (2004). World Development Indicators database, WB website

WHO. (2003). Guide to producing national health accounts with special applications for low-income and middle-income countries. World Health Organization, World Bank, The United States Agency for International Development

17 2006-03-27 List of Health Division Documents

Strategies/Policies Issue Papers

1997:1 Policy for Development Cooperation 1998:1 Maternal Health Care, by Staffan Bergström Health Sector 1998:2 Supporting Midwifery, by Jerker Liljestrand – Replaced by Sida’s policy for Health and Development, 2002 – 1998:3 Contraception, by Kajsa Sundström

1997:2 Política para la Cooperación para el Desarrollo 1998:4 Abortion, by Kajsa Sundström Sector Salud 1998:5 Female Genital Mutilation, 1997:3 Position Paper by Beth Maina-Ahlberg Population, Development and Cooperation 1998:6 Adolescent Sexuality Education, Counselling 1997:4 Positionspapper and Services, by Minou Fuglesang Befolkning, utveckling och samarbete 1998:7 Discrimination and Sexual Abuse Against Girls 1997:5 Marco de Referencia para la Cooperación para and Women, by Mary Ellsberg el Desarrollo Población, Desarrollo y Cooperación 1998:8 Health Care of the Newborn, by Ragnar Thunell 1997:6 Strategy for Development Cooperation Sexual and Reproductive Health and Rights 1998:9 Men, Sexuality and Reproductive Health, by Beth Maina-Ahlberg, Minou Fuglesang and 1997:7 Estrategia para la Cooperación para el De- Annika Johansson sarrollo Salud y Derechos Sexuales y Reproductivos 1998:10 Illicit Drugs and Development Cooperation, by Niklas Herrmann 1997:8 Handbook for mainstreaming – Replaced by 2000:2 – A Gender Perspective in the Health Sector 1999:3 Socio-economic Causes and Consequences 1999 Investing for future generations. of HIV/AIDS Sweden’s International Response to HIV/AIDS by Stefan de Vylder – Replaced by 2001:5 – 2000:2 Guidelines for Action – Illicit Drugs 2000:1 HIV/AIDS in the World Today – a Summary of and Swedish International Trends and Demographic Development Cooperation Implications by Bertil Egerö and Mikael Hammarskjöld 2001:1 Hälsa & Utveckling, Fattigdom & Ohälsa – ett folkhälsoperspektiv 2001:2 Health and Environment by Göran Paulsson, Ylva Sörman Nath and by Marianne Kjellén Björn Ekman 2001:3 Improving Access to Essential Pharmaceuticals, 2002 Health is Wealth – Sida’s Policy for Health and by IHCAR Development 2001:5 A Development Disaster: HIV/AIDS as a Cause and Consequence of Poverty 2002 Health is Wealth – A Short Version of Sida’s by Stefan de Vylder Policy for Health and Development 2001:6 National Health Accounts – Where are 2002:4 Sweden’s Development Co-operation with WHO we today? – a Strategy for the Period 2002–2005 by Catharina Hjortsberg

2003 Health is Wealth – A Short Version of Sida’s 2001:7 Ideas work better than money in generating Policy for Health and Development. (Spanish) reform – but how? by Alf Morten Jerve 2004 Health is Wealth – A Short Version of Sida’s 2002:2 Health and Human Rights Policy for Health and Development. (Russian) by Birgitta Rubenson

2004 Working in Partnership with UNODC/UNDCP 2001 Aids: The Challenge of this Century A Swedish Strategy Framework for 2004–2007 by Bertil Egerö, Mikael Hammarskjöld and Lise Munch

2002 Health Sector Reforms: What about Hospitals? by Pär Eriksson, Vinod Diwan and Ingvar Karl- berg (NHV report 2002:2)

Continues

Health Division Documents and a complete list of earlier publications may be ordered from: Infocenter, Sida S-105 25 Stockholm, phone: +46 (0)8 698 55 80, fax: +46 (0)8 698 56 15 www.sida.se, e-mail: [email protected]

18 List of Health Division Documents

1999 Aidsbekämpning i Uganda Issue Papers cont. 1999 Förebyggande insatser mot drogmissbruk 2002 Sexuality – a super force. Young people, sexual- 1999 Insatser mot familjevåld i Centralamerika ity and rights in the era of HIV/AIDS 1999 Bättre mödrahälsovård i Angola by Anna Runeborg 1999 Utbildningssamarbete Kenya-Linköping 2003:2 Human Resources for Health and Development, 2001 Sveriges stöd till Hiv/Aids-insatser – 2001 by Jenny Huddart Fact Sheets cont. 2004:3 Issue paper on NHA; the case of Kenya, Zambia and Mali, by Anna Glenngård and Frida Hjalte 2002 Fler välutbildade barnmorskor ger tryggare förlossningar 2005:2 Issue Paper on NHA; Findings from a study of regional NHA networks 2002 Femina skapar het debatt om sex och hiv by Anna H Glenngård and Frida Hjalte 2002 Rent vatten ger bättre hälsa och ökad jäm- ställdhet 2005:3 Issue Paper on NHA Policies in the Kenyan health care sector by Anna H Glenngård Sida Evaluations 2006:1 Issue Paper on NHA 98/14 Expanded Programme on Immunization in Zim- Use of National Health Accounts – the Case of Uganda babwe by Anna H Glenngård and Frida Hjalte 99/10 Working with Nutrition. A comparative study of 2006:2 Issue Paper on NHA the Tanzania Food and Nutrition Centre and the The National Health Accounts process in Mali National Nutrition Unit of Zimbabwe by Frida Hjalte 99/11 Apoyo de Asdi al Sector Salud de Nicaragua. Facts and Figures Prosilais 1992–1998 99/36 Support to Collaboration between Universities. 1995/96 Facts & Figures 95/96 An evaluation of the collaboration between MOI Health Sector Cooperation University, Kenya, and Linköping University, Sweden 1997 Facts & Figures 1997 Health Sector 2000 Webs Women Weave. An assessment commissioned by Sida 4 organisations networking for 1999:2 Facts & Figures 1998 sexual and reproductive health and rights. Health Sector 00/2 Reaching out to Children in Poverty 2000:3 Facts & Figures 1999 Health Sector 00/21 The Protection, Promotion and Support of 2001:4 Facts & Figures 2000 Breastfeeding Health Sector 01/03 Tackling Turmoil of Transition. An evaluation of 2002:1 Facts & Figures 2001 lessons from the Vietnam-Sweden health coop- Health Sector eration 1994 to 2000

2003:1 Facts & Figures 2002 01/32 Review of PAHO’s project. Towards an integrat- Health Sector ed model of care for family violence in Central 2004:1 Facts & Figures 2003 America. Final report Health Sector 02/13 Sida’s Support to the Reproductive Health and 2005:1 Facts & Figures 2004 TANSWED HIV Research Programmes in Tanza- Health Sector nia

02/40 Evolving Strategies for Better Health and Devel- Fact Sheets opment of Adolescent/Young people

1997 Hälso och sjukvård 03/19 Sida’s Health Support to Angola 2000–2002 1997 Reformer inom hälsosektorn 04/13 Médecins Sans Frontières – Aral Sea Area pro- 1997 Rätten till sexuell och reproduktiv hälsa gramme, Sida’s Support to Turberculosis Con- 1997 Befolkning och utveckling trol and Treatment 1997 Ungdomshälsa 1997 Handikappfrågor Continues

19 List of Health Division Documents

Sida Evaluations Other documents

04/14 Sida’s Work Related to Sexual and Reproductive 1999:1 Report on: health and Rights 1994–2003 World Youth Conferences in Portugal August 1998, by Wanjiku Kaime-Atterhög 05/26 Programa “Acceso” en el sector de salud de and Anna Runeborg Honduras 2000:6A Framtid Afrika – Huvudrapport Country and Regional Health Proﬁ les 2000:6B Annex to Framtid Afrika – 1995 Angola Health Support in Africa – Country Reports

1995 Bangladesh 1998 Gender and Tuberculosis 1995 El Salvador 2001 Hälsa – en nyckel till utveckling 1995 Ethiopia – New edition 2003 –

1995 Guatemala 2001 Jord för miljarder 1995 Guinea Bissau 2002:3 Rural Integrated Health Services – Kenya, 1995 Honduras by Gordon Tamm

1995 India 2002 Health – a Key to Development 1995 Kenya 2002:5 A follow up of the components for Swedish sup- 1995 Laos port in Burma/Myanmar, Cambodia, China (Yunnan Province), Laos and Vietnam 1995 Nicaragua 2003 Hälsa – en nyckel till utveckling 1995 Vietnam 1995 West Bank/Gaza 2004 Ending gender-based violence: A call for global action to involve men 1995 Zambia 2004:2 Sidas arbete med SRHR 1994–2003 1995 Zimbabwe En sammanfattning av utvärderingen 2000:4 Uganda ”Sida Evaluation 04/14”

2000:5 West Africa 2004 Human Resources for Health – Overcoming the Crisis. Joint Learning Initiative

2005 Poniendo ﬁ n a la violenca de género: Un llamado a la acción global para involucrar a los hombres

Continues

20 List of Health Division Documents

Consultancy Reports

Conditional Grants for Health Sector Support in Uganda African Youth Forum of the United Nations System December 1998 December 2000

Health Systems Development in Uganda – what could Sida Seminar on Sector-Wide Approaches for Health Sweden do within the context of a Sector Wide approach? February 2001 December 1998 Review of Regional Organisations/Networks Working Informal bilateral meeting on Global Health Initiatives in the Area of Hiv/Aids in Eastern and Southern Africa March 2001 August 1998 Adolescent Sexuality in Africa – from Traditional SPANe – Sida partnership on adolescents network Rites to Contemporary Sexuality Education January 1999 April 2001

SPANe – Part 1: Purpose and aim of SPANe, and Part 2: Assessment report of RAINBO’s Africa program Proceedings from the 2nd SPANe workshop, 19–21 october April 2001 1998 in Harare, Zimbabwe January 1999 Assessment report of UNICEF Anti-Female Genital Mutilation Campaign in Eritrea November 6–14, 2000 Swedish NGOs working with International Drug Control April 2001 Issues January 1999 Partner Consultation on National Health Accounts Hiv/Aids in Botswana June 2001 September 1999 Review of Sida support to policy and organisational Resultatanalys av Sidas stöd till insatser mot narkotika development, with particular focus on institutional 1997–1999 (Swedish) collaboration in Zambia Oktober 1999 July 2001

Resultatanalys av Sidas stöd till Hälsa och Miljö inklusive A Background Study on UNDCP Tobaksbekämpning (Swedish) March 2002 November 1999 The Maternal Health Programme in Angola Strengthening the obstetric nurse in Nicaragua November 1999 October 2001 and March 2002 Hiv/Aids in Bangladesh Estudio independiente de pre-evaluacion y situacion December 1999 para el fortalecimiento de la enfermera obstetra en Nicaragua Hiv/Aids in Tanzania Octobre 2001 y Marzo 2002 December 1999 Continued Sida support of Hiv/Aids work within the health Femina Health Information Project sector in Uganda February 2002 March 2000 HIV/AIDS och utvecklingssamarbete Hiv/Aids in Guatemala and Honduras 2003 March 2000 Human Resources and Sustainable Capacity Building The teachers’ training in sexuality education project in for Health and Development Malawi March 2003 March 2000 Overview of Sida’s Work Against Trafﬁ cking in Human SPANe – Report from the 3rd SPANe workshop, october Beings 11–13 1999, in Cape Town, South Africa. ”Truth Time Now” May 2005 April 2000 Appraisal of ESCAP-project Evaluation of HEPNet in SSA May 2000 September 2005

A Fact-Finding Mission on the Health Sector in Albania, The Purchaser-Provider Model and Institutional Kosovo and Macedonia Collaboration in Zambia June 2000 December 2005 Hiv/Aids – a gender-based response June 2000

21 22

Halving poverty by 2015 is one of the greatest challenges of our time, requiring cooperation and sustainability. The partner countries are responsible for their own development. Sida provides resources and develops knowledge and expertise, making the world a richer place.

SWEDISH INTERNATIONAL DEVELOPMENT COOPERATION AGENCY

SE-105 25 Stockholm Sweden Phone: +46 (0)8 698 50 00 Fax: +46 (0)8 20 88 64 [email protected], www.sida.se